Febrile convulsions

Alternative Names:Fever fit,Febrile seizure,Seizure – fever induced

Definition:
Febrile convulsions are seizures associated with a significant rise in body temperature that occur in a child with a high fever of over 39°C (102.2°F).  They most commonly occur in children between the ages of 6 months and 6 years and are twice as common in boys as in girls (Lissauer, Tom-Illustrated Book of Paediatrics 3rd Ed.).

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These most typically occur during the early stages of a viral infection such as a respiratory infection, while the temperature is rising rapidly.

Febrile convulsions can be frightening but they’re rarely serious,  as   these convulsions occur without any brain or spinal cord infection or other nervous system (neurologic) cause.

Three per cent of children have at least one febrile convulsion. There may be a genetic predisposition – up to 20 per cent of relatives will have a seizure disorder including febrile convulsions.

Types:
There are two types of febrile seizures.

*A simple febrile convulsion is one in which the seizure lasts less than 15 minutes (usually much less than this), does not recur in 24 hours, and involves the entire body (classically a generalized tonic-clonic seizure).

*A complex febrile convulsion is characterized by longer duration, recurrence, or focus on only part of the body.

The simpleconvulsion  represents the majority of cases and is considered to be less of a cause for concern than the complex.

Symptoms:-
Febrile convulsions may be as mild as the child’s eyes rolling or limbs stiffening. Often a fever triggers a full-blown convulsion that involves the whole body.

Febrile convulsions may begin with the sudden contraction of muscles on both sides of a child’s body — usually the muscles of the face, trunk, arms, and legs. The child may cry or moan from the force of the muscle contraction. The contraction continues for several seconds, or tens of seconds. The child will fall, if standing, and may pass urine.

The child may vomit or bite the tongue. Sometimes children do not breathe, and may begin to turn blue.

Finally, the contraction is broken by brief moments of relaxation. The child’s body begins to jerk rhythmically. The child does not respond to the parent’s voice.

The seizures are brief, usually lasting only a minute or two and never more than five minutes.  It is usually followed by a brief period of drowsiness or confusion. A complex febrile convulsion lasts longer than 15 minutes, is in just one part of the body, or occurs again during the same illness.

The child loses consciousness, becomes stiff, stops breathing for up to 30 seconds and loses control of their bladder or bowel, wetting or soiling themselves.

Febrile convulsions are different than tremors or disorientation that can also occur with fevers. The movements are the same as in a grand mal seizure.

This stops after a few minutes and the child regains consciousness. Following the seizure they fall into a deep sleep and are often confused or irritable when they finally wake.

Causes:
The convulsions occur because the electrical systems in the brain have not yet matured sufficiently to cope with the stress of a high temperature.

About 3 – 5% of otherwise healthy children between ages 9 months and 5 years will have a seizure caused by a fever. Toddlers are most commonly affected. Febrile seizures often run in families.

Most febrile seizures occur in the first 24 hours of an illness, and not necessarily when the fever is highest. The seizure is often the first sign of a fever or illness

Febrile seizures are usually triggered by fevers from:

•Ear infections
•Roseola infantum (a condition with fever and rash caused by several different viruses)
•Upper respiratory infections caused by a virus
Meningitis causes less than 0.1% of febrile seizures but should always be considered, especially in children less than 1 year old, or those who still look ill when the fever comes down.

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A child is likely to have more than one febrile seizure if:

•There is a family history of febrile seizures
•The first seizure happened before age 12 months
•The seizure occurred with a fever below 102 degrees Fahrenheit

Complications:
In about 15 per cent of cases, the child will have another febrile convulsion during the same illness. They also have a one in three risk of a convulsion during a subsequent illness.

Onset before the age of one and a family history increase the risk of recurrent problems.

Most children grow out of febrile convulsions without coming to any harm. However, about one per cent of children do subsequently develop epilepsy (this is more likely if the child has a longer than normal convulsion, or recurrent seizures in the same illness). Talk to your doctor if you’re worried.

Diagnosis:
The health care provider may diagnose febrile seizure if the child has a grand mal seizure but does not have a history of seizure disorders (epilepsy). In infants and young children, it is important to rule out other causes of a first-time seizure, especially meningitis.

In a typical febrile seizure, the examination usually shows no abnormalities other than the illness causing the fever. Typically, the child will not need a full seizure workup, which includes an EEG, head CT, and lumbar puncture (spinal tap).

To avoid having to undergo a seizure workup:

•The child must be developmentally normal.
•The child must have had a generalized seizure, meaning that the seizure was in more than one part of the child’s body, and not confined to one part of the body.
•The seizure must not have lasted longer than 15 minutes.
•The child must not have had more than one febrile seizure in 24 hours.
•The child must have a normal neurologic exam performed by a health care provider.

Treatment:
During the seizure, leave your child on the floor.

•You may want to slide a blanket under the child if the floor is hard.
•Move him only if he is in a dangerous location.
•Remove objects that may injure him.
•Loosen any tight clothing, especially around the neck. If possible, open or remove clothes from the waist up.
•If he vomits, or if saliva and mucus build up in the mouth, turn him on his side or stomach. This is also important if it looks like the tongue is getting in the way of breathing.
Do NOT try to force anything into his mouth to prevent him from biting the tongue, as this increases the risk of injury. Do NOT try to restrain your child or try to stop the seizure movements.

Focus your attention on bringing the fever down:

•Insert an acetaminophen suppository (if you have some) into the child’s rectum.
•Do NOT try to give anything by mouth.
•Apply cool washcloths to the forehead and neck. Sponge the rest of the body with lukewarm (not cold) water. Cold water or alcohol may make the fever worse.
•After the seizure is over and your child is awake, give the normal dose of ibuprofen or acetaminophen.
After the seizure, the most important step is to identify the cause of the fever.

Prognosis:
The first febrile seizure is a frightening moment for parents. Most parents are afraid that their child will die or have brain damage. However, simple febrile seizures are harmless. There is no evidence that they cause death, brain damage, epilepsy, mental retardation, a decrease in IQ, or learning difficulties.

A small number of children who have had a febrile seizure do go on to develop epilepsy, but not because of the febrile seizures. Children who would develop epilepsy anyway will sometimes have their first seizures during fevers. These are usually prolonged, complex seizures.

Nervous system (neurologic) problems and a family history of epilepsy make it more likely that the child will develop epilepsy. The number of febrile seizures is not related to future epilepsy.

About a third of children who have had a febrile seizure will have another one with a fever. Of those who do have a second seizure, about half will have a third seizure. Few children have more than three febrile seizures in their lifetime.

Most children outgrow febrile convulsions by age 5.

Prevention:
Because  febrile convulsion  can be the first sign of illness, it is often not possible to prevent them. A febrile  convulsion does not mean that your child is not getting the proper care.

Occasionally, a health care provider will prescribe diazepam to prevent or treat febrile convulsions that occur more than once. However, no medication is completely effective in preventing febrile convulsions.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/febrileconvulsions2.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/000980.htm
http://en.wikipedia.org/wiki/Febrile_seizure

http://www.nlm.nih.gov/medlineplus/ency/imagepages/19076.htm

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